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TY  - THES
AU  - Benninghaus, Anne Elisabeth
TI  - Untersuchung der kraniospinalen Liquordynamik zur Therapie des Normaldruckhydrocephalus
PB  - Rheinisch-Westfälische Technische Hochschule Aachen
VL  - Dissertation
CY  - Aachen
M1  - RWTH-2025-00457
SP  - 1 Online-Ressource : Illustrationen
PY  - 2024
N1  - Veröffentlicht auf dem Publikationsserver der RWTH Aachen University 2025
N1  - Dissertation, Rheinisch-Westfälische Technische Hochschule Aachen, 2024
AB  - Normal pressure hydrocephalus (NPH) is a disease of the central nervous system in which excess fluid accumulates in the ventricles of the brain without an increase in mean intracranial pressure. The pathogenesis of the disease is still largely unknown. However, it can be assumed that a disturbance of the CSF dynamics is present. Based on preliminary work at the Department of Medical Engineering, the aim of the present work was to complete the initial hypotheses on the pathogenesis of NPH previously investigated in the context of in-silico simulations by further analysis and modeling of the complex pathophysiological interactions and to verify them in the context of experimental in-vitro investigations using sensitivity analyses. The in vitro model developed in this work is based on four main hypotheses ranging from stenoses and viscoelastic changes of the spinal canal to changes in blood dynamics and their influences on fluid dynamics. In particular, the focus is on the effects of dynamic compliance. A test bench was developed and validated using pressure and flow values. Overall, the in vitro results of the sensitivity analyses confirmed the hypotheses established and substantiated the complex interrelationship of the parameters. Furthermore, the experimental study results confirmed the hypothesis that dynamic compliance can be seen as an initially disturbed parameter in NPH pathology. It was shown that especially the spinal canal and its viscoelastic properties play a major role and that pathological or age-related spinal changes should receive greater clinical attention for the previously cranially focused clinical picture of NPH. A division of NPH patients into patient groups based on in vitro results is proposed. The first patient group has decreased cranial compliance, the second has impaired dynamic spinal compliance, and the third has impaired resorption. This proposed classification needs further clinical investigation. The work also included delineating further questions regarding the pathogenesis of idiopathic NPH. In particular, testing the hypotheses on resorption and cerebral capillary dilation require further histological, experimental (in silico and in vitro), and clinical investigations.
LB  - PUB:(DE-HGF)11
DO  - DOI:10.18154/RWTH-2025-00457
UR  - https://publications.rwth-aachen.de/record/1002301
ER  -